David’s Guide to Getting Our A1C Under 6.0

The A1C test is our best scorecard to show how well we are controlling our diabetes. It measures how much glucose has been sticking to our red blood cells for the previous two or three months. Since our bodies replace each red blood cell with a new one every four months, this test tells us the average of how high our glucose levels have been during the life of the cells.

The experts recommend that we should get our A1C level tested at least twice a year. People who take insulin need to get it about four times a year.

If the test shows that our blood glucose level is high, it means that we have a greater risk of having diabetes problems. Think of the A1C as an early warning system for the insidious complications that we can get down the road when we don’t control our condition.

But what do we mean by a “high” A1C level? Here the experts disagree.

The American Diabetes Association says that we need to keep our A1C results below 7.0 percent. The American Association of Clinical Endocrinologists sets the target at 6.5 percent. The International Diabetes Federation, or IDF, also recommends that most people with diabetes keep their levels below 6.5 percent.

The more our A1C level is higher than normal, the greater the likelihood that we will suffer from one or more of the complications of diabetes. And here too the experts disagree with how they define “normal.”

People who don’t have diabetes have A1C levels below 6.0 percent. That’s the gist of what I wrote here recently in “The Normal A1C Level.” The IDF agrees. But more aggressive endocrinologists say that a truly normal A1C ranges from 4.2 percent to 4.6 percent. That’s what Dr. Richard K. Bernstein wrote in Dr. Bernstein’s Diabetes Solution.

No matter what our level is, we can be sure that lower is better. Unless we drive it so low with diabetes drugs that we run risks of hypos or heart problems. Concerns with these risks are the main reasons why our diabetes organizations set a goal that is higher than a normal level — even though they know from clinical trials, like the UKPDS and the DCCT, that with higher levels we will probably suffer from the serious complications that result from high levels.

Then the question becomes what is our best strategy to bring our A1C level down to normal. Not surprisingly, the experts disagree here too.

The key has to be the level of carbohydrates in our diet. After all, like Dr. Bernstein says, diabetes is a disturbance of carbohydrate metabolism where our blood glucose rises above normal.

But for years the ADA has told us that “The recommended dietary allowance for digestible carbohydrate is 130 grams per day.” On the other hand, Dr. Bernstein’s diet allows no more than a grand total of 42 grams carbohydrate each day. While his books don’t say, he has told me directly that he’s talking total carbs, not digestible carbs.

I know from my personal experience that Dr. Bernstein’s restrictions on carbohydrate do indeed bring our A1C levels down to normal. My most recent test was 4.8 percent — without drugs.

Even before 2007, when I began following a very low-carb diet, for about two years after 2005 one diabetes drug helped me reduce my A1C from 6.8 percent. I know that Byetta works to help us achieve diabetes control, especially when we eat fewer carbs, as I began to do then.

The further benefit of both a very low-carb diet and Byetta is that they will help us control our weight far better than anything else. Since more than 85 percent of all of us who have diabetes are overweight or obese, according to a survey by the U.S. Centers for Disease Control and Prevention, I have to conclude that controlling our weight is a key step in controlling our diabetes.

With diet and weight loss alone we may be able to get our A1C level down to 6.0 or better. But we can sure make it easier on ourselves if we ramp up our metabolism. Physical exercise reduces our blood glucose by improving our glucose metabolism, according to recent studies. That’s the best reason for us to get at least the recommended minimum of 150 minutes of moderate-intensity exercise each week.

The other leg of diabetes control has always been to take one of the 10 classes of diabetes drugs we can use. Until we bring our A1C level down to normal, taking one of these medications is essential. I know that taking a couple brands of sulfonylureas and then metformin helped me before I was able achieve my greatest benefit from Byetta.

We tend to forget the importance of reducing the stress in our lives through readily available tools like relaxation and meditation. Likewise, we are just beginning to realize the huge role that reducing inflammation can play in getting control of our diabetes.

Even the amount of sleep that we get can help us control our weight, which probably will help us control our blood glucose level. A new study less than a week ago shows that identical twins who slept between 7 and 8.9 hour each night weigh less than those who regularly sleep either less or more.

These tools are the keys to getting our A1C levels down to normal so we can control our diabetes, instead of letting it control us. All of them are important. But nothing works better than a very low-carb diet.

This article is based on an earlier version of my article published by HealthCentral.

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I am a freelance medical writer, advocate, and consultant specializing in diabetes. I was diagnosed with type 2 diabetes in February 1994, I began to write entirely about that condition. My articles and columns have appeared in many of the major diabetes magazines and websites.

I finally feel like I’m beginning to understand all this….it’s been very frustrating and so complicated. My mother has had diabetes for some quite time now. Was always on 1x 500mg Metformin in the a.m. A1C was typically 6.1 which we never really thought was terribly bad. She was overweight but didn’ eat horrible.Looking back now there was definitely room for improvement though. Dec. 2015 my sister passed away…and that’s when my mom started having lots of medical issues. Cardiac, stomach and for the 1st time ever her A1C shot up to 7.1 Her endocrinologist added another 500mg of Metformin at nighttime. About a month later, she started getting sick regularly. Body aches, fatigue, tiredness, nausea, no appetite that would last about 3-4 days.. almost like clock work every month. I didn’t put 2 and 2 together and thought it was her cardiac medicine. Fast forward 8 months. She lost about 30 lbs. Her A1C went down to 6.6 but we highly think it was the 2nd Metformin that was making her this sick. The doctor finally took her off the 2nd. She went a little over 1 month without getting sick until this month when boom she got sick again. We don’t know what to do. It’s so upsetting and even more so seeing how sick she gets. Doctor took her off all Metformin on the 10th and she had bloodwork done yesterday. We are waiting for the results to see how to proceed. He mentioned a medication named Tradjenta which he says has few side effects. My mom and I are terrified of anymore medications at this point. I have so many questions.
1) Can the metformin have caused her to get sick monthly considering the amount of weight she’s lost and how much less she was eating?
2) Does anyone have any feedback on this medication or is currently on this? I read it may actually cause Pancreatitis 🙁

My A-1 C was tested in August and just recently in March. They both came back borderline diabetic I’m a 48-year-old female who does strength training two times a week (and have been for 4+yrs regularly) and walk 3 miles a minimum of two days a week. I weigh 170 and have lost 17 pounds since August. I have followed the medifast 5 and 1 program since Nov. No alcohol, dairy, or added sugar. What else can I do to lower my A1C? I should mention my father and both grandfathers suffered from adult onset diabetes.

Hi , im 25 years old and at a weight of 303 and I’m 6 ‘1 . for the past couple of years I’ve been dealing with pre diabetes and my numbers danced around a bit from 6.3,6.3,6.2(down from exercise and diet )6.4 then 2 weeks ago it’s now 6.5 . I asked my doctor if I Should come back in and he said just lose weight and will ‘re test in June . I know there has to be two different a1c test to confirm but is there anyway I could lower the numbers before June and be okay? Also Ive been working out for the past 2 weeks and will continue to till I reach my goal.

Your weight is a huge problem for you, Frank. Your BMI says that you are morbidly obese. You have to bring it down more than 100 pounds or risk an early death or terrible complications. Forget about whether you have diabetes or not—you almost certainly already have it. Working out will help a little bit, but you need to eat less every day. A whole lot less. It will be easier on a very low-carb diet, which will also reduce your A1C level.

Have just being diagnosed of T2 diabetics.
How do i manage this situation,i have fluctuating readings from morning till night
i don’t exactly know what to eat and what not to eat at this point.I am a bit confused.Can someone help me out of this?I am based in Lagos Nigeria

I hear your concern, John! First, please tell us what diabetes medicine you are taking. Then, we need to know your A1C level and you BMI (Body Mass Index). Those are the crucial levels for you to know at all times. Meanwhile, you have to cut back, or cut out if possible, grains (wheat, rice, etc.) and potatoes. It is the high-glycemic foods that make your blood glucose levels so high. You can see the complete list of foods that have been tested for their glycemic levels at mendosa.com/gilists.htm

I was diagnosed with type 2 just 4 months ago with an A1c of 10.7. I refused drugs, changed my diet to moderately low carb, added herbs and supplements and recently tested at a 5.9 A1c! I’m confident I’ll get to my goal of under 5.5 soon enough. I am grateful to people, and websites such as yours that help me sort through the conflicting information out there.

Thank you. I immediately cut out pasta, grains, breads, rice, potatoes, sweet potatoes, corn, beans/lentils/legumes, most fruits and all sweets. The only fruits I consume are blueberries, some strawberries and raspberries, but only in small amounts. My diet is about 60% fat (from nuts, seeds, avocado, salmon, olive oil, dairy) 20-30% protein and 10-20% carbs. My diet is basically veggies (raw and cooked) with some sort of protein (tempeh, beef, chicken, fish, eggs, seeds, nuts). I lost 50 lbs and try to keep active – walks, elliptical, resistance band training. I supplement according to my personal constitution for overall health, not just for diabetes. I take magnesium, vit D, B50 complex, chromium with vanadium. I also incorporate chia seeds, cinnamon, burdock/ginger/dandelion decoction, stinging nettle nourishing infusion, milk thistle seeds and others that are not really relevant unless you are a middle aged perimenopausal female ;). I reversed my fatty liver by this change, which I had for more than 10 years. Good luck on your journey! It’s not easy at times, but it is so very worth it!

Last October, I wrote to you about my A1C situation. It had finally dropped below 6.0. However, the next several tests were back above 6.0…. with no change in diet.
Well, the good news is this: It has finally happened! My last three A1C tests were…in order… 5.2, 5.5, and 5.2, for an average of 5.3 over the last 3 months. FINALLY! It feels good to have gone below that 6.0. When we consider that in November of 2014 I was at 16.6… that really tells about a journey back to decent health.

Needless to say, my doctor is thrilled because we did this without medication. He had suggested it in the beginning, but I wanted to try it without, and he agreed…reluctantly. Now to just keep doing what I’ve been doing, and all should be well.

Yes, you absolutely do need to keep taking metformin. Only when you get your A1C level down below 5.5 can you think about stopping it. Otherwise, you are almost certain to get diabetes, which is incurable.

Hi Don. Can you share some specific diet changes you incorporated? And if you don’t mind me asking your weight, age, and BMI. First endocrinologist my mom saw totally dismissed my sister passing away as contributing to my mom’s rise in A1C and pretty much told us she’d be on meds permanently. Needless to say, we sought a second opinion.

David,
I just have a few questions. My husband is type 2. His doctor has him on metformin, and other meds-but we cannot keep his blood sugars below 150-last check up his A1c was a 8.7.
We eat mainly proteins, fruits and vegetables.
Diabetes has brought his weight down to 120 or less.
I am really frustrated as i do not know what else to do for him!!
help!
Thank you,
Cathy

David, I just had my labs done. Have followed Dr. Bernstein’s book & also Wheat Belly for 3 months. A1c is now 6.0 down from 7.4 three months ago. Cholesterol is 155 down from 183. My problem is the triglycerides! They have always been high, 3 months ago they were 249 and now 212. How do I lower these? I’m taking 1290 mg. Omega 3’s three times a day as well as fenofibrate.

Thanks for asking about triglycerides, Vicki. What works by far the best is a very low-carb diet. My level was as high as 252 when I was diagnosed with type 2 diabetes. But now, after I have followed a very low-carb diet for about 10 years, mine have been measured at 47, 45, 58, 43, 79, 51, 62, and 76. The normal range is from 40 to 150.

I’m so confused. My cholesterol values are all good. My glucose is stable (100), but my A1C is 6.3 and my doctor is considering putting me on Metformin. Is that drastic. Shouldn’t losing weight and dietary changes be the first line of treatment?

That level of 100 says that you have prediabetes, Teri. I think that your doctor’s recommendation is a great one for you and not drastic at all. But be sure to start with a very low dose of metformin and work up gradually (please see my article here, “Metformin Forever.”) Losing weight and exercise is the other great way to prevent your prediabetes from turning into diabetes. But the problems with that are that it takes a lot longer to have an effect and in fact it most people just don’t do it. So the best of both worlds is to combine what you suggest with what your doctor recommends. Avoiding diabetes, which can’t be cured, has to be a huge priority in your life, Teri.

Hi,David.I’ve been cutting way back on starches and sugar.Now,I have a question.Are oats and flax safe to eat,or are they as bad as wheat?I notice you warn about potatoes,wheat and rice.I’m just curious.

Hi
3 months ago my a1c was 5.5. My dr Just did a follow up and it is now 6.1. He said cut back on starches and has not diagnosed me as diabetic yet. Boarder line he said.
I drink a bottle of dry red wine a night and eat plenty of starches along with salads , veggies,meat fish. Etc.
My question is , if I cut back on wine and starches can I lower my a1c to a point where I can enjoy the starches and wine again?

If you cut back on the wine and starches, you will be able to avoid getting diabetes, which can lead to some awful complications that I probably don’t need to write more about. You will get used to this superior way of eating. The first thing that needs to go are potatoes, closely followed by anything milled from wheat, and then rice. Good luck to you and thanks for asking, Mike.

I am pleased to be able to report that my latest A1C test is down to 5.9 …finally! Considering it was 16.6 just last November, and had hovered in the 6.3-6.6 range for 3 months, for it to drop to 5.9 is a huge relief.
Credit goes to the change of diet AND the workout program that I have started to build up… now up to 5 workouts per week… doing both Cardio and weights.

I am a 69 years old female ,I had a1c test done and it is 6.2. I am 5′ 8″ and weigh 157.My dr. said that is prediabetic.I take long walks at least 4 times a week.I walk about 3 miles each time.My sugar # was 98.
I love breads,potatoes etc.If I cut out the starches and continue my walks,will that drop my a1c #s quickly?I do not take diabetes drugs.My doctor hasn’t suggested them.I’m glad i found your page,so much good info here.

Yes indeed, Margie. Cutting out starch is sure to bring your A1C level down considerably and probably into what most people would consider the normal range. That is below 6.0, although I think that the normal range is probably less than 5.5. However, since the A1C test measures your average blood glucose over the past 3 months or so, it does take some time for the test to reflect your new and much greater control. I sure hope than you are able to avoid getting diabetes!

David,
I am a 44 yr old male 6′ 2″ 345 lbs. I have been diagnosed with type 2 diabetes. I am taking metformin and glipizide (???) currently. Approximately 5 months ago I had the a1c test which resulted in a 11.7. I have been eating fairly normal and have had a hard time cutting my sweets intake. My next a1c was in September and results were 9.6. Headed the right direction but not fast enough as my DOT physical needs to be at 8.0. My question is if I can cut the majority of sugar out will this help to get my 9.6 down to the 8.0 I need?
It has currently made me change positions and I can no longer drive till the number reaches the legal minimum.
Thanks

Actually, Rob, a goal of 8.0 is hardly satisfactory. Even the most easy-going organizations say that it has to be 7.0 or below, and certainly to be normal, which less chance of complications later on, it has to be below 6.0.

Cutting out sugar is certainly important, and it is actually very easy to do, at least compared with all the other changes that people with diabetes, like you and me, have to make to manage our disease well. We have a great substitute non-caloric and natural sweetener: stevia. I use only the SweetLeaf brand.

But cutting out sugar probably won’t even get your down to 8.0 on your A1C test. You have to cut way back on the starches. Starchy food is first, potatoes, especially baked and mashed potatoes. They simply have to go. Almost as bad for our blood glucose and probably a lot WORSE for our health in general is wheat, particularly milled wheat. That means, of course, bread, bagels, etc. I recommend going cold turkey on wheat products, if you can. If not, definitely limit them. Third in importance, but still very important is to eliminate rice from your diet. With these changes, your A1C will come down a lot, but remember that the A1C test measures your average blood glucose over the previous 3 months, so it can take some time to register. Hope this helps and good luck in managing your health.

Also by cutting out sugar and starch from your diet you will be able to get down to a normal weight. At your weight and height you are by definition morbidly obese. But it is possible to save your life and actually to make it much better. I have been there myself. Ten years ago I weighed 312 pounds at the same height as you, actually 6’2.5″ and total my weight in half of that. I did it on a very low-carb diet, and you can do. My A1C level has been around 5.5 for years, and you can get there too.

I have read the answers you gave to all questions and I see that most of my questions were already answered. I just need to know if I can lower my A1C Level in 30 days-is it really possible. My A1C was 9.0 down from 10.0. I am on Lantus Solostar and Humalog pens. I weigh 189 lbs and I know my weight is a problem. Had major C1-2,T11 down my back 10-11 inches due to an anachroid cyst. Still not back there, plus I had 3 other back surgeries including a fusion on my L5,4-S1. Both total hips and left/right achilles repair, and various other surgeries. I am need of another surgery, and trying to do this lowering fast yet safely….

You certainly can reduce your A1C level in 30 days, Nancy. The A1C test measures your average blood glucose level for the past two to three months, depending on several factors. But about half of it comes from your level during the previous 30 days.

Mr. Mendosa: I have been diagnosed with type 2 diabetes for approximately 15 years. I remembDr as a young teenager always being thirsty and urinating alof. Now at 60 years of age my A1C is out of control. Last test indicated it as being 16 extremely high. I have gotten my blood sugar levels under control and I am to see my doctor next month (October) for my A1C reading. I am nervous because I crave sweets so bad. Please help me. I know what to do it’s just doing it.

I understand, Desiree. When I was diagnosed with diabetes 21 years ago, my A1C was also extremely high, 14.4. I have been able to control it and for years it is been about 5.5. But I too still crave sweets. That’s not a problem because I satisfy my sweet tooth with a natural sweetener, Stevia. I do hope that your doctor has you on insulin because you need to bring down your blood sugar level ASAP in order not to worsen your chances of complications. Eventually, you will, I hope, be able to control your diabetes with a very low-carb diet alone. Of course, what you must do is to right now cut way back on the starches that you eat, particularly wheat and all of its products, potatoes, corn, rice, etc. Of course, sucrose and fructose are also harmful to your body, but they are very easy to avoid by switching to a non-caloric sweetener like stevia. The key to your problem could actually be something you didn’t mention, your weight. When we bring our weight down to a normal level, i.e. a BMI of less than 25, it is so much easier to manage our diabetes. And a very low-carb diet is the easiest way to lose weight.

I am a 61 year old male. I am in excellent physical condition and do extensive toning and cardio training 3-4 x per week. My last 3 A1C scores have been 5.7, 5.8 and now 6.0. It keeps going up and I want to reverse this. Is significantly reducing my carb intake the key? What else can I do? Thanks

Yes, a very low-carb diet is one of the two most important keys, Lee. The other is to get down to at least a normal weight, where you BMI is below 25, and when it is considerably below 25, it gets even easier to get your A1C level down. Of course a very-low carb diet works both for a low A1C and for a low BMI.

This is for Charlotte who mentioned her low vitamin D and osteoporosis. You might visit parathyroid.com, and consider having your serum calcium levels checked as well as your PTH (parathyroid hormone) before embarking on additional vitamin D. Dr. Norman seems to be quite an expert on parathyroids, and hyperparathyroidism can cause osteoporosis and low vitamin D. He says that serum calcium in the 10s suggests hyperparathyroidism in adults, and explains that lab reports don’t always state that clearly. Some show “normal” as being up to 10.4 or so, which he strongly disagrees with.

The key for you to avoid diabetes, Jane, is to bring your weight down to normal. I know from my personal experience that this isn’t easy, but I also know that I did it and you can too. Probably the easiest way for you is to follow a very low-carb diet.

Sad news, I get steriod injections and my A1C was 15! I have given up all carbs started doing protein shakes and 1 meal = 1 protein and veggies. Scared to eat fruit. I take 35 units of Lantus & recently purhased fast acting wal mart brand (I dont think it works) .Advice please on how to get this down and save my life!

That is sad, Lynn. But steroids like Prednisone can often make people’s blood sugar level go through the roof while at the same time being necessary for treating other conditions. They are very powerful drugs for both good and bad. You are doing what I would be doing if I were in your shoes. Taking insulin as you do is the quickest way to get your blood sugar level down to normal where you will have little or no risk of the complications that high levels can cause. In the long term you may not need insulin, unless you have type 1 diabetes, when you follow your very low-carb diet. Taking Lantus or Levemir, each of which is a long-acting basal insulin, is the first one to take. Then, as you added a fast-acting insulin you can get even better control of your blood sugar levels, albeit at the cost of much greater vigilance. That’s because you have to closely match the amount and peak action of the fast-acting insulin with the spikes of the food that you eat. When you eat few carbs, particularly when you avoid all flour and grains as well as potatoes, you won’t have those spikes, but we know now that protein will also cause some increase in our blood sugar level. So fast-acting insulin can be tricky to manage and it can help you if you are able to consult with a Certified Diabetes Educator through an appointment at the medical clinic you go to.

I just did some research and found that Pritikin indeed did not finish college. He did become an inventor of note, however, and eventually dedicated his life to dealing with heart disease, etc.
It is worth noting that he may very well receive…posthumously…if possible…a Nobel Prize in medicine. If so, he would be the first lay person to be so honored.

Yes, it would be remarkable if a layperson won the Nobel Prize in Physiology or Medicine. And even more remarkable for it to be awarded to someone who has been dead for so many years.

It’s not going to happen. For example, see this from Wikipedia:

Although posthumous nominations are not presently permitted, individuals who died in the months between their nomination and the decision of the prize committee were originally eligible to receive the prize. This has occurred twice: the 1931 Literature Prize awarded to Erik Axel Karlfeldt, and the 1961 Peace Prize awarded to UN Secretary General Dag Hammarskjöld. Since 1974, laureates must be thought alive at the time of the October announcement. There has been one laureate, William Vickrey, who in 1996 died after the prize (in Economics) was announced but before it could be presented.[50] On 3 October 2011, the laureates for the Nobel Prize in Physiology or Medicine were announced; however, the committee was not aware that one of the laureates, Ralph M. Steinman, had died three days earlier. The committee was debating about Steinman’s prize, since the rule is that the prize is not awarded posthumously.[4] The committee later decided that as the decision to award Steinman the prize “was made in good faith”, it would remain unchanged.[51]

First, I used Dr. Pritikin’s dietary guidelines because they were proven to have worked. He got people off the “typical American diet” that was much higher in fat and cholesterol, and onto one that served to fuel endurance athletes for marathons…and longer distances.
As one test, he sponsored 3 entrants in the Ironman Triathlon in Hawaii. They had competed before without notable success. They had to agree to use his dietary guidelines 100%, and to copy their training exactly as they had done it the year before. That latter part was easy to do because any serious endurance athlete routinely keeps a log book of his or her training.
The result? They finished 4th, 2nd…and first! Considering that their only change was to Pritikin’s guidelines, I’d say that was quite an achievement.
Further, his diet is based on that of the Tarahumara Indian Tribe (you can Google them). It is a tribe that has never had coronary artery disease. I think you will find them to be…fascinating!
As for my own diet, I got rid of things such as lasagna and other such frozen dishes from the Encore company. I stopped eating pizzas and (sadly) Chinese food). I still avoid red meat as much as possible, preferring to go with ground turkey and…sometimes… extremely lean ground beef. Yes, I do the salad routine, too, but carefully watch what is being added into the salad. I have no sugar in the house. I’ve had some occasional meats that are in “burger” form with a few additives that are okay. Thankfully, the level of sodium is not high, so that problem will not wind up biting me in the foot.
I also managed to find one brand of bread from Pepperidge Farm that is very low in carbs: roughly 8 grams per slice. This is in comparison to other breads that have double or even triple that amount! (It helps to be able to read labels!) It allows me to have sliced turkey sandwiches and not worry about carbs going wild on me.

Oddly enough, it was thanks to my eye doctor that this entire sleigh ride came to pass. In a routine eye exam he spotted something in the back of my eye. He said it could only be from 1 of 2 possibilities. The first we discounted immediately. The second: diabetes. That was when the first blood test was done at the hospital. When the results came in, he sensed the obvious danger to my health, and told me to see my regular physician. He (my regular doctor) ordered that 2nd A1C test, and now you know the rest of the story.
By the way, I don’t mean to belittle your claims about Nathan Pritikin. However, his research into coronary artery disease was ground-breaking, and totally refuted the theories of Dr. Bassler…who said that anyone who did not smoke and could run a marathon in under 4 hours was immune to heart disease. Bassler was proven wrong.
The case of the late Jim Fixx comes to mind. Fixx wrote “The Complete book of Running”, the first really good book on marathon training. He died one day after a 20-mile training run…a routine distance for him! When the VT medical examiner’s office did the autopsy, they found his cholesterol to be about 253… and his own doctor told him that was “completely normal”. As far as I can see, 253 is NOT normal at all! While it may be “okay” for someone who plays cards all day long, it is NOT okay for anyone who aspires to being an endurance athlete.
During my marathon-running years, I went 100% with the Pritikin guidelines, and they worked. I was able to finish all 11 marathons without trouble, including the final 2….just 2 weeks apart from one another. Obviously, I had a very fast recovery from the first, and the time differential between the two was barely 5 minutes… a negligible difference.
I will research Nathan Pritikin to see about his college situation. It seems hard to believe that anyone would use the term “Doctor” who is not a duly licensed physician. Here in NH we have one such person, and he may well lose his practice. He had a license and then surrendered it because he knew he was going to have it taken away.

Check out Jason Fung’s (MD Canada) website!
I’ve had excellent results using his method, and
he has a great series explaining diabetes, and why
blood sugar isn’t the problem Diet is low
carb with fasting–nothing extreme! David,
what do you think?

I am curious about your opinion of the work of the late Dr. Nathan Pritikin, and his Pritikin Diet.
To explain: I used to be a serious runner, doing 3-4 marathons annually and a host of other road races. When I ruined my left MCL, I was advised to stop running because the MCL would not be able to take the pounding.
I tried 6 different ways to rehab the knee, but nothing worked, so I turned to coaching other runners.
My error was to remain on the same diet I had been using when running marathons! High in complex carbs, low in fat, and moderate in protein.
Over the years, my weight slowly increased. Last November, during some routine blood tests, they told me that my A1C was “sky high” at 16.6. The following month, my own physician had me take another A1C test, and it registered as 14.4. He told me to immediately change my diet.
I followed that advice. By April, my A1C was don to 7.2. In June it was down to 6.3 on the same diet. Surprisingly, in July it went up a bit to 6.6. However, this morning it registered as 6.3 (I am doing home testing, by the way).
The only real difference now is that I am working out at the Y about 4 times each week, usually putting in 4 or more miles each time on the treadmill. That program started about a month ago, so perhaps that is the reason for the drop back to 6.3.
Oddly, my weight has not budged since starting to work out. I am not taking any medication for the sugar problem, nor do I wish to do so if I can avoid it.
One other oddity: It seems that the knee is holding up on the treadmill, as I have added in some jogging at 6-8 MPH…nothing overly fast, and for 30-45 seconds at a time before slowing down to 4.0 MPH. In this one month, my heart rate is significantly lower than it was at the same speed, so it is obvious that my conditioning is starting to come back…even though I will never again be a real runner. I have no fear of raising my pulse to 80% or even 90% of maximum (I’m in my mid-60s).
Comments are welcomed.

Interesting that you ask for comments on diet — without writing what your diet is! However, I will comment on Nathan Pritikin, who advocated an extremely low fat diet.

First, you call him Dr. Pritikin. I can forgive this because it is an all-to-common mistake. In fact, Pritikin was no doctor. He didn’t even have a bachelor’s degree and dropped out of college after two years.

More importantly, Pritikin’s diet was an extreme version of the disastrously recommendations of Ancel Keys, who cherry-picked European data for his Seven Countries Study that later were made into U.S. government policy by the McGovern commission and subsequently taught by the American Diabetes Association that have been responsible for the misery and death of many people around the world, particularly those of us who have diabetes.

I hope that I express my comments clearly but I had to hold myself back.

So, what is your diet that helps you to get a somewhat better A1C level but not lose weight?

Thank you for all the good info. Have had no “white stuff”. beef, pork, very seldom chick, no sweet stuffs, for 30 years, but enjoy lots of fruit, eat an Ezekiel 4:9 wrap with avocado, hummus, beans, mixed greens, garlic, turmeric, flaxseed meal, drink coconut milk and eat oats everyday. Recently diagnosed with extreme negative numbers on bone density, had lost down from 125-130 to 108, now weigh 113, had experienced tremendous stress from several directions for 1 1/2 years. Collapsed and have been extremely weak in bed and very little sleep for 6 weeks. Started eating mixture of foods with melatonin before bed :banana,walnuts,tart cherry juice.. helps most nights. Have managed to get up for a little while each day depending on sleep for past two weeks. And I used to run circles around all my friends! Now I am happy if I slowly walk 3 blocks away in late eve. My fasting glucose is 92 , A1c is 5.8 (lab said should be lower than 5.7). triglycerides 70, HDL63. LDL96. D-24.6. My challenge and question is how to gain weight, get enough calcium, and D3., protein, good fats eat my servings of fruits and stay alkaline, lower sugar, get my fiber, ..exercise but not too much for the bones… etc….Trying to balance all this needs a PhD in fitness and nutrition!! , I want my energy back!!! HELP! Please! I am shocked about the osteoporosis diagnosis (I am an outside person and have had a difficult time figuring out my limits ) and absolutely bewildered and frustrated with the prediabetic numbers. Do I need to simply be patient with my slow progress, relax and learn to say NO!? Any wisdom appreciated.

Stress can make your health problems so much worse, Charlotte. It could be what you need to address first. The way I deal with stress is through meditation, which can in fact help us in many ways. I don’t know anything about dealing with osteoporosis, but I do know that your vitamin D3 level is too low and you can manage it well, as I do, with 5000 IU/day. Actually, I would be surprised if you need more protein because almost all Americans get too much. But as someone who knows how hard it is to LOSS weight, I can highly recommend avocados, nuts and seeds, and cheese to help you gain weight. They work too well for me.

When people get diagnosed with diabetes, Tina, they are either scared or in denial about it. Being scared is better! But even being scared doesn’t help.

Diabetes doesn’t cause any complications. Only uncontrolled diabetes does. Your A1C level of 6.1 is actually much less than typical when diabetes is diagnosed. Mine, for example, was 14.4. So, of course, in my case it was essential that I brought it down to normal as soon as possible. You, on the other hand, have much less work to do than I did when I was diagnosed.

Where to start is indeed the right question. You probably do have a doctor who is treating you, so start with the advice and prescriptions of your doctor, nurse, and/or diabetes educator. I would hope that your doctor has prescribed a diabetes medicine, particularly metformin or insulin shots. These are the usual starting drugs — insulin works very quickly to bring down our blood sugar level to normal. In your case, you don’t actually have far to go to get to normal, so I would think that metformin is what you are taking. Is that right? But when you take metformin, you have to increase the dosage very, very slowly in order to avoid nausea and other stomach upsets. Most doctors don’t tell you to titrate your level slowly enough, so read my article on “Metformin Forever.”

When people are diagnosed with type 2 diabetes, which I assume you have, they weigh too much. What is your BMI? If it is above normal, it is a major contributing factor to your A1C level being above normal. Weight loss is essential as a start for you then. Metformin is usually weight neutral or can help you lose a little weight. Insulin and most other drugs for diabetes on the other hand lead to significant weight gain. A relatively new class of drugs, however, can help you lose weight. These are the GLP-1 agonists including Bydureon, Victoza, and Byetta. When I took Byetta for about 2 years, I was able to lose a significant amount of weight.

Eventually, however, I realized that any drug can have negative side effects, some perhaps not yet discovered in the general population. So I decided to lose weight — and control my diabetes at the same time — by switching to the only other feasible alternative for me — a very low-carbohydrate diet. It is essentially only carbohydrates that cause our blood sugar to be too high, so a low-carb diet works wonders for both weight loss and blood sugar control.

I could go on with more information. In fact, I have in the thousands of articles I have written about diabetes in the past 20 years. But these are the essentials of what you need to know to start. Don’t be scared.

Yes, Carmen, your level is far too high. You need to bring it down very quickly in order to avoid some very serious complications that will come from your uncontrolled diabetes. To bring down your level right away there is only one way: insulin injections. You must get your doctor to prescribe them.

You will not have to take insulin shots for the rest of your life if you eat right. Eating right for people with diabetes means eating very few carbohydrates. I have written many articles about a very low-carb diet that I encourage you to read here.

Hey !!!!,
I’m 16 and was diagnosed with diabetes ( type 1 ) just 6 months ago , The last time I got my A1C checked out it was 6.5 , I’m on a vegan diet don’t know if that is good for my condition ?!
I really wanna get my A1C lower and I’m willing to do whatever it takes !!!!!

It is difficult, but not impossible to manage your diabetes on a vegan diet, Rivka. I have been able to do it on a vegetarian diet, because it gives me the amount of protein that I need from eggs and dairy. Actually, I would like to follow a vegan diet myself for the sake of the planet, but I don’t think that it is healthy over a long term (other people certain may disagree with me). Your A1C level is much better than I would have thought from being diagnosed so recently, but it is certainly higher than it should be. At a minimum to avoid complications in the many years that you have ahead of you, it’s necessary to bring it down to normal or better as soon as possible. The normal level is certainly 5.7 or even less (people disagree about this). If I were in your shoes, I would immediately study one book: “Dr. Bernstein’s Diabetes Solution.”

Hi David,
I will have to look up this Dr. Bernstein of wich you speak… however, in the meantime, maybe you could answer a few questions for me?
I’m 33, 5’11”, & weigh between 125-135. My caloric intake is around 1000 daily. I obviously don’t need to loose weight, I’ve just never been a big fan of bread, & too many sweets make me feel terrible. My last a1c was a 5.5. My Dr. tells me “that’s fine”. When I asked her if the criteria for normal a1c was based on a 2000 calorie diet & if so, how does my diet play into this scenario? She looked confused… does Dr. Bernstein say anything about this?
My second question is regarding a1c & red blood count. If one’s rbc is low, does this also play into the overall meaning of a1c test results?
I surely hope these questions won’t be too bothersome. .. I wouldn’t be asking you if I could find the answers on-line. If you help me, or even just point me in the right direction that would be great!
Thanks & have a fabulous day!

You ask some excellent questions, Amber! First, your A1C and weight numbers are wonderful. Second, your doctor may be confused about the basis for a normal A1C level. It has nothing to do with how much people eat but rather what the levels of people who don’t have diabetes are. It’s clear that a normal level is below 6.0 but it is probably a whole lot less. My guess is that it is not above 5.4 and Dr. Bernstein thinks that it is around 4.5. The problem is to find and test people who are young, thin, and apparently healthy, because these people are about the closest we can get to normal. I look into this in depth at http://www.mendosa.com/blog/?p=366 . This post has a lot of comments too, many of which are quite valuable.

I am about 10wks pregnant. My dr did an a1c test and said it came back boarderline. I don’t have the number yet because I haven’t seen her. Three weeks before I had this test I had the stomach bug/sickness from being pregnant and all I could keep in me were carby things. My question is would this make the results of the test not be accurate. Should I request that she retest me before sending me to a specialist?

Good question, Amanda. But, no, your sickness would have very little impact on your A1C level. That’s because the A1C measures your level over a much longer period of time, about three months. Eating a high carb diet for a short time would also have little impact. But it certainly will, if you stay with it.

Am 57 6 foot 3 at 205 male. A diabetic2. Was a commercial truck driver for 14 and on the road most of the time. Ignorance/unknown lead to a problem my right foot was not getting enough blood and with diabetes a ulcer formed. Uncureable lost my leg from the knee down 2013. Recieved a notice from my state DOT wanting to downgrade my licence no medical card as I went on SS disability. Recently noticed my A1c was too high for a DOT card at 8.1 I failed to lower the count within a months time again 8.1. Now changing doctors medicare begin. I take Invokana and simvastatin for diabetes control. What exactly is the problem carbs, medicine or both?

My a1c a year ago was 9..9 in July was down to 7.9 and down to 5.9 now. I am on metformin 2,000 a day and Glipside twice a day. I have lost 15 ponds but my height is 5′ and I weigh 164. But I have been exercising 4 days a week. Just not losing weight and my sugars are running a little higher now around 130. What can I do to get it lower and lose weight

I am sure that you know your basic problem. With the height and weight numbers you provided your BMI is 32.0, and that puts you well into the obese range. You have two good choices, and the best is to immediately begin to follow a very low-carb diet, as I have written in many of my articles here. The other is to get your doctor to prescribe one of the new GLP-1 medications, Bydureon or Victoza. Actually, what worked best for me and for many people it to do both.

I am a 53 y/o male and I thought in great shape, until my blood work showed a 5.9 A1C. I stand 5’4″, weigh 138 lbs, have a 29-30″ waist (since high school) and exercise 5 to 7 days a week. Cardio, weights, core body and swimming- normally swimming 2 days a week. My weight has always been steady and diet was always “healthy” with the exception of drinking a caffeinated soda daily, I also eat rice at least once a day (normally twice) and I love cookies and donuts. Well, I guess I will be cutting a lot of that out. Finally, I know I do not get enough sleep (4-5 ours daily). (BTW- there is no history of diabetes in our family)

After reading your blog, I have several questions;
1) How worried should I be about my A1C developing to an uncontrollable level (diabetes).
2) Could the stress from all the exercise & lack of sleep be causing the elevated A1C?
3) Besides cutting back on the carbs & soda what other dietary suggestions do you have?

An A1C of 5.9 probably means that you have pre-diaberes, but you are right on the cusp of diabetes. You are smart to be taking action now because you have a good chance of never getting diabetes, which has no cure. Pre-diabetes does have a cure. Of course, if you don’t make any changes in your diet, you will get diabetes.

Stress and lack of sleep can indeed cause a higher blood sugar level, but it’s generally much less of a factor than poor diet. By poor diet I mean eating foods that will impact your blood sugar level. Those foods are the ones that are high in carbohydrates, including the grains, like rice and anything made from wheat. Potatoes also have a great impact. The other major change I’m guessing that you need to make is to avoid sugar as much as possible. While technically, there are many types of sugar, the problematic ones are fructose and sucrose.

My AC1 is 7.4 and have been a diabetic for 30 years and have been on Glyburide Metformin , my
Doctor just increases the dosage to 1000 mg in the morning and 1000 mg in the night, is glyburide Metformin a good medication? I understand that I need to control carbs but am more confused if my medication is effective.

I understand your doctor’s decision. He or she wants you to bring your A1C level down to no more than 7.0, which is a standard (although I am convinced that it should be much lower, less than 6.0; but that’s a different question). Increasing the amount of your medicine is necessary unless you reduce the amount of carbohydrates you eat. It should be effective and the metformin part of the medicine is the safest medicine for diabetes of all except for insulin, and the dosage your doctor prescribed is the standard maximum level. The Glyburide is, however, a medicine that I would not want to take because of some suspicion that it might burn out the beta cells of your pancreas (the cells that make the insulin in your body). Glyburide, like all sulfonylurea drugs, do that.

Thanks for all you do. 45 years old and got diagnosed this week with a 6.5. First blood test ever. I’m 6′ and 185 lbs. Typically walk 12-16 miles weekly plus winter hiking. Pretty good diet. Problem is I figured I’ve been drinking a shocking 184 grams of sugar a week via alcohol. Peppermint Schnapps and beer. I also smoke on those 3 nights I typically drink. So that’s now done. Do u think I cut out the alcohol and smokes with increased walking to 20 miles weekly I can get that number down to something normal, say in the high 4’s/low 5’s? I’m convinced the booze is the culprit as I eat pretty well and regularly exercise. Not an alcoholic but drink socially with the neighbors so stopping that won’t be difficult. Thanks

I am glad to help. Beer could indeed be your problem causing you to consume too many carbs. It is far higher in carbs than any other alcoholic drink. And it is a decided plus that you will not be smoking any more now that you have stopped drinking it. You can indeed get your A1C down into the normal range by reducing the amount of carbohydrate you eat (and drink). Keep testing your A1C level regularly for confirmation.

The rise in your blood sugar was probably due in large part to stress. If so, this makes it all the more important not to get stressed out about it. You have shown that you can control your blood sugar once, and you can certainly now do it again.

Again, thanks for all you do to help diabetics (and those who hopefully may avoid diabetes) through education.

In the last three months, I went from a personal low A1C of 5.4 up to a 5.7 and I am very concerned. I am a type 2 diabetic, taking metformin only, at 1000 mg. a day. I have lost a lot of weight, but my weight has stabilized.

I did recently have some stressful things in my life, including having gallbladder removal and starting a new job. Could that really make my A1C jump that much in the course of four months? My diet has been somewhat less strict, but basically I’m eating around the same.

Dear David, I followed you, and Dr Rollo when my daughter got diabetes at 10years old. She is 32 now, and her 4 year old son has Type 1 diabetes as well. I am almost 69 and got type 2 about 9 years ago. I went on insulin almost immediately. ( I suspect latent type 1. I set up my own insulin regimen and see a regular physician. My a1c is 5.4 right now. I have decided I should see an endocrinologist however as there seem to be so many new developments on the horizon. Could you recommend some endos in the Kansas City area?

Dear David,
I was just diagnosed with type 2 diabetes and my A1C was 8.7. My diet consisted of mostly carbs (white bread and pasta) and lots of soft drinks. Since being diagnosed I have completely changed my lifestyle. In 3 months I’ve lost 30 pounds, I haven’t had a soft drink, and I have reduced my carb intake greatly (between 4-6 servings a day) also any rice or bread is whole wheat. I am taking metformin but only 250mg 2x/day.
Is it possible for me to get to a normal A1C if I continue on this route or was my A1C too high to bring down to “normal” non-diabetic level?
I had one Dr. tell me it was possible to reverse my diabetes, because I am young and because he said I eat too much, that if I cut down my food intake I`ll be able to reverse it. Possible? or not?

Yes, indeed, you can put your diabetes into remission where you won’t suffer its consequences (complications) and be healthier and happier than ever before. You will need to get down to a low body mass index (i.e., lose a lot of weight) and get your A1C down to 5.5 at least. You are doing great and are on the right path. But you will almost certainly need to go farther. Whole wheat bread and brown rice are in fact little (if any) better than the usual. Unless you eat very little of these flours and grains you will find it very difficult to manage your diabetes. The good news is that you can give up the grains and feel much better too.

A1C 13,stopped taking insulin because I could not (for 13 years)get my shoulder fixed,stopped exercise,now I went to a DR outside of the VA,surgery on hand scheduled soon,pre op screening means I must take insulin again,how much insulin is safe to take 2x a day

I am a 44 yr male. 220 pounds. 5/7. I was currently diagnosed with type two. A1c was 7.9. I’m currently taking meteformin. Question. I been walking two . Three miles almost daily. Trying to eat right. Is 7.9 very bad. With my changes in diet and exercise will this lower my numbers. When I walk numbers come down. Meteformin reduces the numbers with good results. Signed. Nervous abourt this disease. Thanks

Thanks for your response David I appreciate it. No I am not overweight my BMI is like a 19 or 20.I weigh only 118 pounds and I am 5 ft 5 inches tall.I am afraid if I start on a low carb diet I will lose weight but I am more afraid of diabetes.Do you know what types of foods I can eat that can help me avoid losing weight and still keep my A1C levels under control.The doctor said I was at risk for pre-diabetes will take this test again in a couple months.

What you need to eat are exactly those good foods that I usually have to sacrifice in order to get my weight down to my goal! I try to stay thin and keep my BMI at 19.5. When I do have it down there (right now after lots of travel I have 3 pounds to lose), I eat avocados, cheese, and macadamia nuts. All of these foods, and many more, have lots of the best fats. I know from my own experience that it’s easy to put on pounds when I eat as much of them as I like!

Hi I am a 49 yr old female 5ft 5inches 118pds.I have always had good glucose levels and numbers.I just got my A1C test back which was 5.9 would like to know how I can lower it.I am not a diabetic do have family history of it.

Since you don’t have diabetes (yet), you probably have only one choice (which may be in two parts). You can’t usually get a prescription for a diabetes medication unless you already have it (sometimes your doctor will prescribe metformin for people with pre-diabetes, which it sounds like you have). Your choice, part 1, is to lose weight if you are overweight, i.e. have a BMI above 25 (see http://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm ). In any case, your best course of action is part 2, to eat fewer carbohydrates, particularly those with a high glycemic index (see http://www.mendosa.com/gilists.hmt ).

I have an A1C of 6.0. My cholesterol is borderline high as well, and I was told to stay with whole grains because of the valuable fiber content. Is it the whole wheat by itself that raises glucose or just the amount you eat? Between trying to reduce cholesterol, blood pressure and now blood glucose I have no idea WHAT’s safe to eat!

Fiber may be useful, although not everyone agrees and we certainly have been ways of getting it in any case than eating grain. Nuts and seeds and even some fruit like avocados are loaded with fiber. A book that you really need to read, “Good Calories, Bad Calories,” by Gary Taubes has an entire chapter on fiber. He shows that we really don’t need it, at least through the consumption of grains. He shows evidence that the very few studies that “try” to link low-fiber intake to an increased chance of colon cancer are unfounded. Dr. Michael Eades has an eye-opening post on fiber too. Please see:

Hello! I am a skinny diabetic. I am 6 feet, one inch and weight 166 lbs. I am a male . My last a1c was 6.4 and my doctor was not concerned also my diabetic dietition says wheat bread and wheat products are slowly digested and are ok

Isn’t it sad that so many people still believe that wheat and wheat products are good for us! It’s sad too that their standards of blood sugar control are so lax. No wonder that so many of us get complications from diabetes.

At my last doctor visit, my a1c came back at 6.0. I’m pleased, but would like to get it down further. I asked the doctor for suggestions, and she said that number was just fine – normal – and so I didn’t really need to. I don’ t agree. I already eat fairly low carb so is increasing my exercise my best bet? I take 2000 of Metformin a day, no other diabetes drugs.

I agree with you that 6.0 is not good enough. We can do better and reduce the risks of complications. But I think that going even lower carb will make more of a difference than exercise, except perhaps after meal exercise like I just wrote about today at HealthCentral.

I now know why the doctor’s office was freaking on me….I had labs done last Friday and my A1C is 9.9, Glucose 267…..lots of others were high as well. I was given a two week period of time to get the A1C going down – what are the best foods to do this?

It’s not the foods that you need to eat but those you need to avoid. Foods high in carbohydrates are those that raise your blood sugar level. These are particularly grains, especially wheat and anything made from it (bread, muffins, cake, pasta, etc.), corn, rice. Also avoid potatoes. Those are not all, but are the worst ones for you.

I am a thin, healthy woman 5’7 120 lbs but have recent A1cs of 5.9 and 6.0. I had gestational diabetes with both pregnancies and after second, did not go away. I eat a very low carb diet bc I’d prefer not to use meds, if possible. But I generally try to keep postprandial readings under 140. Is that too high?

Many people would say that 140 is not too high. But you can do better on a very low-carb diet even without drugs, by cutting out the starches and sugars. I know that my level is usually 80-90 and rarely above 100. That is safer!

The whole problem with diabetes is the complications. Diabetes itself causes nothing. But high blood glucose causes the complications. The best studies there are show conclusively that blood glucose levels above normal can cause complications. Please read my entire article about what a normal blood glucose level is. It’s at http://www.mendosa.com/blog/?p=366

I haven’t read all the comments, but I just switched
to brand name glucophage XL, just like Dr. Bernstein says, and it has really worked well! I can even have a small amount of whole grain bread! I have 0nly been on it about three months–my daily readings are about 80 to 95, as compared
to 95 to 115 on the generic metformin–only drawback is my insurance company wont pay for the brand name, but it’s worth it to me to have the lower readings–no weight gain problems–give it a try–good luck–

Your comments and information is inspiring! I’m trying very hard to control my A1C however am frustrated! I have never been obese but have lost approx. 15 lbs over past few years and now weigh 145 lbs. , height 5′ 7″ with my A1C around 7. I know that I ate too many high carbs this past summer so I know that I contributed directly to that number. On top of that I have other digestive problems which mean I cannot eat several foods i.e. peppers, onions plus am lactose intolerant. Knowing that lower is better, and I don’t want to gain weight I’m concern about my options. I have seen stats that some drugs (and insulin) can cause weight gain of up to 22 lbs. and I definitely do not want to gain weight. I’m on 2500 mg met, 1 Januvia per day. Plus I take PGX that I THINK helps but am not sure. Do these numbers indicate I should be moving directly to insulin? Appreciate your comments.

I don’t think that your numbers say that you have to go on insulin now, but that is a judgment call between you and your doctor, not something that I can tell you. The drugs that you take are some of the best in terms of not leading to weight gain (although Byetta and Victoza are much better, because they can help you lose weight). The main things that you need to do to bring your A1C down to a normal level is to follow a very low carb diet, like Dr. Richard K. Bernstein recommends in “Dr. Bernstein’s Diabetes Solution” and getting more activity. You can do it!

I just finished reading the link you sent me, “Why I Low-Carb”. What an inspiration!

Many years ago, in my pre-diabetes younger years, whenever I needed to lose a few pounds, I’d go on a low-carb diet limiting my carb intake to 60 carbs per day until I lost the 10-15 pounds I wanted to lose. Then came the news that diets low in carbs but high in fat were not healthy, so I switched over to what I thought was the best of the best and began following a diet based on the glycemic index. I was no longer successful losing weight, it seemed, and somewhere along the way, I developed Type II. At least I was eating healthy, so I thought. Since my diagnosis, I’ve been struggling, trying to get my weight back under control and my numbers down. I’ve managed to lose only one-third of the weight I need to lose. My blood pressure is still too high and my cholestral numbers are still backwards (what should be lower is higher; what should be higher is lower). In my best efforts, I’ve never had an A1c below 6.0 and my meter readings have never been below 98. In fact, I feel ill whenever my meter reads a score of 100 or less!

As usual, I have found inspiration at your website and a renewed passion to begin again, something I had lost along the way as I began to despair. Thank you for your continued efforts to share your knowledge of living with diabetes with the rest of us.

I feel encouraged now. I have ordered a copy of Dr. Bernstein’s latest book, and tomorrow I will begin again: 6 grams of carbs for breakfast, 12 each for lunch and dinner, and 12 for a snack.

David, I agree with the others, you look fantastic! I didn’t realize that you were not taking any meds at this time. To me, this means you have reached a significant milestone in your personal battle with Type II. Congratulations!

The last I knew, you were taking Byetta. Please expound on where your life has taken you since then.

I do mean LOW carb — about 40 to 60 grams of carbohydrates per day. No more. Yes, the American Diabetes Association and most dietitians would you have a low fat diet instead. But it is the carbohydrates, not fat or protein, that raises our blood glucose levels and makes us unhealthy. I could go on and on about this, but please just start by reading my article “Why I Low-Carb” at http://www.mendosa.com/lowcarb.htm

Hi David,
Thank you for this web site. Diagnosed with type 2 last year and had a recent a1c of 5.8 but am tired a lot and up at night to use the bathroom. Even though my a1c is good, could I still benefit from meds? Was on Junovia at one time and felt better.

Since your A1C level is in the normal range, I wonder if something else is going on. Being tired and having to pee a lot are indeed symptoms of diabetes — but they are symptoms of UNCONTROLLED diabetes. If I were in your shoes, I would ask my doctor for a complete checkup.

What about Symlin? Is anyone out there using symlin? I have been for 3 months, it seems to help with my sugar levels, as long as I exercise and don’t do too much high carbs.
But I have found that exercising after a meal helps more than anything. I would like to hear from others using symlin. It has not been the miracle I was hoping for, but I have reduced my insulin.

what about teas? I love green tea and use several types including Genmaicha (green tea with popped rice for a nutty finish) and green teas with various floral and fruit rinds for flavoring. Since I use loose leaf tea and steep directly, would I get a enough carbohydrate from the popped rice to matter? I just drink the tea, and use the solids for compost.

I am 46 year old female — very slim — 5’2.5″ tall and 107 pounds. My fasting glucose has never been above mid 80s. However, my A1C is 5.1 which Dr. Bernstein says in unnacceptably high. Both my parents and only sibling have type 2 diabetes. My sibling and mother are obese, my father slim. I do take thyroid meds for hypothyroidism. I eat low carb to control my weight but since I am very slim and more active in the summer — I tend to overeat fruit in the summer. I try to take long walks every day — these range from 30 minutes to over an hour. I also tend to binge on nuts. My triglycerides are always very low — 45 or even lower — 22 at a recent test. How worried should I be about the 5.1 AIC??

Good question. I have a female friend who is also slim like you who is also concerned about an A1C level in the same range. But that range does seem to be a normal level, according to everything that I have been able to find. Normal, but perhaps not optimal. With a very low-carb diet, you can, as Dr. Bernstein recommends, bring it down to an optimal level.

It’s not easy to for me to keep my weight off! I weigh myself every day when I’m home, and when my weight creeps up more than a pound or two, I immediately cut back on how much I eat. While I don’t count carbs or calories, I pretty know the contents of foods by now and judge accordingly. I do follow a very low-carb diet like Dr. Bernstein recommends, which is no more than 42 grams of carbohydrates per day. I also get a lot of exercise. Without both, it would be hopeless for me.

hi dave– i just saw a picture of you at your new weight! I knew you lost weight, but the picture is
inspiring!! Great work!

I have a question regarding how you are maintaining your weight. I’m BMI 22, A1C 5.9, and eat low-carb, use metformin, ALA, and vinegar. Problem is that while statistically my weight is fine (all advisors say why bother to lose weight), I’m left with handfuls of fat rolls around the waist!, which I suspect contribute to why I can’t seem to get my A1C down further.

I’ve tried lots and lots of exercise–run, bike, hike, swim, triathlons–but I’m really tired of so much exercise which isn’t giving me the results I want–and, the more I exercise, the more I need to eat (even tho it’s lo carb)!

Specifically my question is 1)are you following Dr. B’s diet exactly–ie, do you strictly! monitor carbs to the 30 that he recommends, 2)are you reducing your calorie intake or your fat intake as well? (contrary to G. Taubes, etc.)

You are right on the borderline of having diabetes, and your weight doesn’t necessarily cause it.

As to chocolate, not likely. In the first place, chocolate per se has little effect on blood glucose. The sugar in most chocolate does, but only to much extent among people who have diabetes.

You have been warned by your doctor that you are on the road to full-fledged diabetes. Please take the necessary steps now to avoid it. Those steps are most importantly to get a lot of exercise and control your weight by eating right, i.e. by avoiding a lot of carbohydrates, particularly the sugars and starches like wheat flour (and anything made from it like bread), potatoes, rice, and corn.

I have always had a normal glucose level. This year it was 113 which my doc said was high. They did an A1C which came back at 6.3 which they said was high. I am wondering if eating a lot of chocolate during the previous 4 months would give an abnormal test result. I have never been diagnosed as diabetic and don’t have any symptoms. I am just barely 62 and no more overweight now than I was the last 30 years of my life. Just wondering whether a chocolate binge affected the test result. Any thoughts?

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I am a freelance medical writer, advocate, and consultant specializing in diabetes. I was diagnosed with type 2 diabetes in February 1994, I began to write entirely about that condition. My articles and columns have appeared in many of the major diabetes magazines and websites. Read more